Doctor insights on:
Microangiopathic White Matter Disease

1

Patchy insulation:
Chronic means this process has been going on for years in the brain. White matter is the part of the brain where the "communication cables" are, and they are "white" because of myelin insulation. The ventricles are fluid-filled "shock absorber" spaces inside the brain. Ischemic means they have been deprived oxygen, microvascular means in tiny blood vessels. Mini-stroke strips off some insulation.
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White matter is one of the two components of the central nervous system and consists of glial cells and myelinated axons that transmit signals from one region of the cerebrum to another and between the cerebrum and lower brain centers. White matter tissue of the freshly cut brain appears pinkish white to the naked eye because myelin is composed largely of lipid tissue veined with capillaries.
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2

Lack of blood deep :
In the brain. This condition is most commonly seen in individuals with one or all of the following:
1. Hypertension
2. Diabetes
3. Hyperlipidemia (high cholesterol)
4. Cigarette smoking
5. Family history of stroke
of course there are others but these are most important. Please meet with your neurologist to discuss why and what you can do to help your situation. Good luck and well wishes.
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4

See your doctor:
Hyperintense white matter signals may mean nothing clinically or could be related to a host of diagnoses, including multiple sclerosis, autoimmune, etc. It has to be correlated to an exam and other testing to make any sense of it, a lot of times it is an incidental finding and means very little clinically. Your doctor will help you understand what this report means to you clinically.
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6

Subcortical ischemia:
This translates to changes in the smaller blood vessels that lead to loss of blood flow to the area and then scarring. Somewhat like a small silent stroke and frequently seen in people with migraines. The opinions about this have swayed from very worried, to common and mundane and more recently back to looking to stop the damage (help the blood flow, oxygen and glucose status optimize).
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7

NONSPECIFIC :
Although the films were read as suggesting ischemia, location might also suggest prior head trauma, congenital lesions of no consequence, genetic or hereditary issues, even underlying inflammatory condition. This is only "serious", if clinically you are having stroke symptoms or you possess uncontrolled blood pressure or elevation of blood lipids. Likely quite non-diagnostic.
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8

Why did you get it?:
If the radiologist knew your age and still read the report in that way I think that is a little bit unusual. But, it kind of depends on the reason you had the MRI done in the first place. Typically, that type of a read would be more common for someone who had long-standing hypertension, diabetes, high cholesterol, smoker for many years and so forth. Do you have a copy of the report or the films
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10

Concern for MS, But:
Phyllis, talk to the doctor who ordered the MRI, since he/she can interpret the MRI in the context of the symptoms that brought you to the clinic. In some cases, periventricular white matter lesions are the result of migraines, old head trauma, neuron migration issues, or MS. It is hard to know from just a description of the MRI which is the cause. Good Luck and Stay Healthy!
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12

Unlikely:
It would be unusual for a focal hyperintense focus in white matter to be a tumor; however, one needs to better understand what the specific sequence used on MRI (T1, T2, FLAIR, T* etc) to be more informative.
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13

Described often:
Presume on mri, white matter lesions as noted, which are usually nonspecific, but can be associated with hypertension, diabetes, or high blood fats causing "hardening of the arteries" (aka, microvascular angiopathy). This pattern might be consistent with ms in some cases, so needs correlation for relevance. Not a description of stroke, but an indication for prevention of future stroke.
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14

Becoming a senior:
These changes in signal in the white matter are believed to be due to small vessels losing their flow. This is a finding in older or senior citizens. It remains to be seen if they amount to anything as we age
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18

Nonspecific finding:
White matter changes that are nonspecific are sometimes over reported or under-reported on MRI studies. They may be misread and really suggest MS, they may be a finding with no clinical relevance. Usually it is the latter.
It sounds like the brain MRI did not help that much. So you shuffle your feet and drop? What do you mean by drop? Do you have numbness? Why was the brain MRI done?
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